Cited by 547Musculoskeletal pain and rehabilitationFibromyalgia and Chronic Fatigue Syndrome ResearchPain Management and Treatment

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Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review

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Luque-Suarez, Alejandro, Martinez-Calderon, Javier, Falla, Deborah·2019·British Journal of Sports Medicine

DOI 10.1136/bjsports-2017-098673

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Abstract

OBJECTIVE: (1) To explore the level of association between kinesiophobia and pain, disability and quality of life in people with chronic musculoskeletal pain (CMP) detected via cross-sectional analysis and (2) to analyse the prognostic value of kinesiophobia on pain, disability and quality of life in this population detected via longitudinal analyses. DESIGN: A systematic review of the literature including an appraisal of the risk of bias using the adapted Newcastle Ottawa Scale. A synthesis of the evidence was carried out. DATA SOURCES: An electronic search of PubMed, AMED, CINAHL, PsycINFO, PubPsych and grey literature was undertaken from inception to July 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies exploring the role of kinesiophobia (measured with the Tampa Scale for Kinesiophobia) on pain, disability and quality of life in people with CMP. RESULTS: Sixty-three articles (mostly cross-sectional) (total sample=10 726) were included. We found strong evidence for an association between a greater degree of kinesiophobia and greater levels of pain intensity and disability and moderate evidence between a greater degree of kinesiophobia and higher levels of pain severity and low quality of life. A greater degree of kinesiophobia predicts the progression of disability overtime, with moderate evidence. A greater degree of kinesiophobia also predicts greater levels of pain severity and low levels of quality of life at 6 months, but with limited evidence. Kinesiophobia does not predict changes in pain intensity. SUMMARY/CONCLUSIONS: The results of this review encourage clinicians to consider kinesiophobia in their preliminary assessment. More longitudinal studies are needed, as most of the included studies were cross-sectional in nature. TRIAL REGISTRATION NUMBER: CRD42016042641.

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Efficacy of Cognitive Behavioral Therapy for Kinesiophobia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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“11 This phobic response establishes a self-perpetuating cycle - diminished physical activity precipitates muscle atrophy and joint stiffness, thereby exacerbating pain perception and reinforcing movement avoidance.”
Central Sensitization and Psychological State Distinguishing Complex Regional Pain Syndrome from Other Chronic Limb Pain Conditions: A Cluster Analysis Model
Karpin, H., Vatine, J., Kirshenboim, Y. B., Markezana, A., & Weissman‐Fogel, I. (2022) · Biomedicines · doi:10.3390/biomedicines11010089 · Cited by 9
“A systematic review among chronic musculoskeletal pain patients revealed that a greater degree of kinesiophobia is associated with greater levels of pain intensity, pain severity, disability, and a lower quality of life [77].”
Background
Correlates of musculoskeletal pain and kinesiophobia in older adults with heart failure: A structural equation model
Sentandreu‐Mañó, T., Deka, P., Bonet, L. A., Tomás, J. M., Alguacil-Sancho, L., López‐Vilella, R., Klompstra, L. V., & Marqués‐Sulé, E. (2023) · Geriatric Nursing · doi:10.1016/j.gerinurse.2023.07.003 · Cited by 9
Examining Psychological Factors as Contributors to Pain, Disability, and Physical Function in Geriatric Chronic Low Back Pain: A Prospective Analysis of the Delaware Spine Studies Cohort
Knox, P. J., Simon, C. B., Pohlig, R. T., Pugliese, J. M., Coyle, P. C., Sions, J. M., & Hicks, G. E. (2023) · Journal of Pain · doi:10.1016/j.jpain.2023.12.005 · Cited by 10
Does Kinesiophobia Associated with Poststroke Neuropathic Pain and Stroke Severity?
Koca, T. T., Gülkesen, A., Nacitarhan, V., & Özlem, K. O. C. A. (2019) · Fiziksel Tıp ve Rehabilitasyon Bilimleri Dergisi · doi:10.31609/jpmrs.2019-66862 · Cited by 9
Effectiveness of Deep Water Running on Improving Cardiorespiratory Fitness, Physical Function and Quality of Life: A Systematic Review
Kwok, M. M. Y., So, B. C. L., Heywood, S. E., Lai, M. C. Y., & Ng, S. S. M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159434 · Cited by 9
“It is common for people with musculoskeletal conditions to report lower levels of QoL—including in domains related to physical function—due to fear and pain [13].”
Background
Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: Evidence and future directions
Alcon, C. A., & Wang-Price, S. S. (2022) · Frontiers in Pain Research · doi:10.3389/fpain.2022.959609 · Cited by 10
Altered upper limb motor behavior in breast cancer survivors and its relation to pain: A narrative review
Baets, L. D., Vets, N., Emmerzaal, J., Devoogdt, N., & Groef, A. D. (2022) · The Anatomical Record · doi:10.1002/ar.25120 · Cited by 11
“From such persistent posture and movement-related pain conditions in non-cancer populations (Gatchel et al., 2007; Lewis & O'Sullivan, 2018; Lin et al., 2020), it is known that pain catastrophizing, pain-related fear of movement and protective motor behavior (i.e., avoidance behavior) have a main…”
Background
Digital Rehabilitation for Elbow Pain Musculoskeletal Conditions: A Prospective Longitudinal Cohort Study
Janela, D., Costa, F., Molinos, M., Moulder, R. G., Lains, J., Bento, V., Scheer, J. K., Yanamadala, V., Cohen, S. P., & Correia, F. D. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159198 · Cited by 8
Prevalence and associations of kinesiophobia with patient reported outcomes and mobility measures in axial spondyloarthritis
KIEFER, D. M., Braun, J., Kiltz, U., Kolle, N., Schneider, L., Andreica, I., Buehring, B., Sewerin, P., Redeker, I., Tsiami, S., et al. (2025) · Joint Bone Spine · doi:10.1016/j.jbspin.2025.105873 · Cited by 8
The Relationship Between Kinesiophobic Attitude and Frailty in Older People
Genç, F. Z., & Bilgili, N. (2025) · International Journal of Nursing Practice · doi:10.1111/ijn.70002 · Cited by 8
The Relationship of Kinesiophobia and Pain Catastrophizing with Pain, Range of Motion, Muscle Strength and Function in Osteoarthritis
Gür, O., Başar, S., Esen, E., Ataoğlu, M. B., & Turanlı, S. (2021) · International Journal of Disabilities Sports & Health Sciences · doi:10.33438/ijdshs.980343 · Cited by 8
Is it Possible to Reduce Pain-Related Fear in Individuals with Knee Osteoarthritis? a Systematic Review of Randomised Clinical Trials
Martínez-Calderón, J., Flores-Cortés, M., Morales‐Asencio, J. M., Galán, C. P., Ríos, M. D. C. G., Torrontegui‐Duarte, M., & Luque-Suárez, A. (2022) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2022.2038743 · Cited by 8
The influence of local pain on balance control in patients with chronic ankle instability
Chen, Y., Cao, S., Qian, L., Chen, W., Wang, C., Ma, X., Wang, X., & Huang, J. (2022) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-022-05656-4 · Cited by 8
“Recent pieces of literature focusing on CAI and pain tried to explain this by kinesiophobia [50].”
Background
Physiotherapeutic treatment associated with neuroscience of pain education for patients with chronic non-specific low back pain - single-blind randomized pilot clinical trial
Yamada, A. S. (2023) · Ağrı - The Journal of The Turkish Society of Algology · doi:10.14744/agri.2022.33349 · Cited by 8
Occupational self-perception level effects on the development of kinesiophobia in individuals with total knee arthroplasty
Yılmaz, G. G., Akel, B. S., Saitoğlu, Y. S., & Akı, E. (2023) · Journal of Orthopaedics · doi:10.1016/j.jor.2023.07.020 · Cited by 8
Changes in Quality of Life, Adherence, and Kinesiophobia in Patients with Hemophilia Treated with Extended Half-Life Treatment: Final Results of the LongHest Project
Ucero‐Lozano, R., Pérez‐Llanes, R., Cuesta‐Barriuso, R., & Donoso‐Úbeda, E. (2024) · Pharmaceuticals · doi:10.3390/ph17070835 · Cited by 8
Predictors of Disability Attributed to Symptoms of Increased Interrecti Distance in Women after Childbirth: An Observational Study
Crommert, M. E., Flink, I. K., & Gustavsson, C. (2021) · Physical Therapy · doi:10.1093/ptj/pzab064 · Cited by 8
The association and reliability of the frontal plane projection angle during the lateral step down test on knee function in patients with patellofemoral pain
Mansfield, C. J., Rethman, K., Stephens, J. A., Stasi, S. D., VanEtten, L., & Briggs, M. S. (2022) · The Knee · doi:10.1016/j.knee.2022.04.010 · Cited by 8
Influence of kinesiophobia on pain intensity, disability, muscle endurance, and position sense in patients with chronic low back pain—a case-control study
Kandakurti, P. K., Watson Arulsingh, D. R., & Patil, S. S. (2022) · Trials · doi:10.1186/s13063-022-06406-6 · Cited by 9
“Furthermore, confounding variables were not always explored in all included studies [18, 35].”
BackgroundInfluential
Kinesiophobia Is Related to Acute Musculoskeletal Injury Incidence Following Concussion
Thompson, X. D., Newman, T. M., Donahue, C. C., Erdman, N. K., Statuta, S. M., & Resch, J. E. (2022) · Journal of Sport Rehabilitation · doi:10.1123/jsr.2022-0134 · Cited by 8
Association of non-chronic low back pain with physical function, endurance, fatigability, and quality of life in middle- and older-aged adults: Findings from Baltimore Longitudinal Study of Aging
Gonçalves, T. R., Cunha, D. B., Mediano, M. F. F., Wanigatunga, A. A., Simonsick, E. M., & Schrack, J. A. (2022) · PLoS ONE · doi:10.1371/journal.pone.0277083 · Cited by 8
“Moreover, individuals with LBP may be more reluctant to perform functional activities due to kinesiophobia (fear of movement), regardless of their real ability to perform them [45].”
Background
Evaluation Tools Developed for Rett Syndrome
Lotan, M., Downs, J. A., Stahlhut, M., & Romano, A. (2023) · Diagnostics · doi:10.3390/diagnostics13101708 · Cited by 7
“The consequences of FOM may be a significant barrier to the acquisition of functional movement and ambulation in girls with RTT and may cause the development of secondary limitations [85,86].”
Background
The Efficacy of the Addition of tDCS and TENS to an Education and Exercise Program in Subjects with Knee Osteoarthritis: A Randomized Controlled Trial
Montilla‐Herrador, J., Lozano-Meca, J. A., Lozano-Guadalajara, J. V., & Gacto‐Sánchez, M. (2024) · Biomedicines · doi:10.3390/biomedicines12061186 · Cited by 7
Effect of cervical traction on cervicogenic headache in patients with cervical radiculopathy: a preliminary randomized controlled trial
Jellad, A., Kalai, A., Chaabeni, A., Nasrallah, C. B., Nsir, A. B., Jguirim, M., Sriha, A. B., Frih, Z. B. S., & Bedoui, M. H. (2024) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-024-07930-z · Cited by 9
“The Tampa Scale for Kinesiophobia (TSK) was employed to assess the fear of movement [39, 40].”
Method
Unraveling the impact of kinesiophobia on proprioception and balance: Mediation by pain, mobility, and psychological wellbeing in post-total hip replacement recovery
Alshehri, S. H. S., Reddy, R. S., Alshahrani, S. M., Alnakhli, H. H., Gautam, A. P., ALMohiza, M. A., Alyami, A. M., Adal, S. Y. A., Dixit, S., & Alyazedi, F. M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0314627 · Cited by 9
The effectiveness of education for people with shoulder pain: A systematic review
Zhang, Z., Ferreira, G. E., Downes, J. S., Cockburn, J. V., Burke, W. J., Malliaras, P., Filho, L. F. S., Maher, C. G., & Zadro, J. R. (2024) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2024.103246 · Cited by 8
Evaluation of kinesiophobia, central sensitization, and related factors in patients with gout: a cross-sectional study
Tuncer, K., Kozanoğlu, E., Sarıyıldız, A., & Yetişir, A. (2025) · Clinical Rheumatology · doi:10.1007/s10067-025-07862-6 · Cited by 7
“Kinesiophobia is defined as an excessive, irrational, and debilitating fear of movement because of a feeling of vulnerability to worsening injury or re-injury [7, 8].”
Validation of a Model Predicting That Physical Activities Improve Health-Related Quality of Life in Older Japanese Adults with Pain, Dysesthesia, and Kinesiophobia after Lumbar Surgery: Structural Equation Modeling
Higuchi, D., Watanabe, Y., Kondo, Y., & Miki, T. (2022) · Pain Research and Management · doi:10.1155/2022/4147497 · Cited by 7
Clinical Assessment of Chronic Musculoskeletal Pain—A Framework Proposal Based on a Narrative Review of the Literature
Nogueira, H. C., Zanca, G. G., & Haik, M. N. (2022) · Diagnostics · doi:10.3390/diagnostics13010062 · Cited by 7
Cross-cultural adaptation and validation of the Mental Health Quality of Life (MHQoL) questionnaire in a Chinese-speaking population with chronic musculoskeletal pain
Wang, J., Wang, R., Zhao, P., Han, T., Li, M., He, Y., & Liu, Y. (2023) · BMC Psychology · doi:10.1186/s40359-023-01482-y · Cited by 7
“It includes chronic myofascial pain, fibromyalgia (FM), chronic widespread pain (e.g., chronic fatigue syndrome (CFS)), rheumatoid arthritis, spondyloarthropathies, and a diagnosis of osteoarthritis [23]; (3) A score of ≥ 3 on the Visual Analog Scale (VAS) for pain (4).”
Impact of yoga asanas on flexion and relaxation phenomenon in women with chronic low back pain: Prophet model prospective study
Marotta, N., Alessandro de, S. I. R. E., Lippi, L., Moggio, L., Tasselli, A., Invernizzi, M., Ammendolia, A., & Iona, T. (2024) · Journal of Orthopaedic Research® · doi:10.1002/jor.25790 · Cited by 7
“38,39 The pain ‐ relieving effects of yoga may be attributed to various mechanisms, including the activation of endogenous pain modulation systems, the promotion of relaxation and stress reduction, the release of endorphins, and the improvement of body awareness and posture.”
Background
Low back pain and kinesiophobia in pregnant women
Koca, T. T., & Özer, A. (2024) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-240006 · Cited by 7
Are women with endometriosis more likely to experience reduced physical performance compared to women without the condition?
Silva, T., Oliveira, M., de Oliveira, E. M. M., Macena, R., Silva, G. T. D. O., da Câmara, S. M. A., & Micussi, M. T. A. B. C. (2024) · PeerJ · doi:10.7717/peerj.16835 · Cited by 7
Physical Function, Self-Perceived Physical Fitness, Falls, Quality of Life and Degree of Disability According to Fear and Risk of Falling in Women with Fibromyalgia
Denche-Zamorano, Á. M., Pereira-Payo, D., Collado‐Mateo, D., Adsuar, J. C., Tomás-Carús, P., & Parraça, J. A. (2024) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk9030174 · Cited by 9
“This fear is often associated with higher pain intensity, disability, and lower quality of life in patients with chronic pain and may mediate the relationship between pain intensity and self-reported disability [45,46].”
Background
İLERİ YAŞLARDA KİNEZYOFOBİ
Güzel, R., İrdesel, J., & Kutsal, Y. G. (2021) · STED / Sürekli Tıp Eğitimi Dergisi · doi:10.17942/sted.899387 · Cited by 7
Chronic Pain and Fear-Avoidance Beliefs: A Narrative Review
Panhale, V. P., Walankar, P. P., & Khedekar, S. S. (2021) · International Journal of Health Sciences and Research · doi:10.52403/ijhsr.20210634 · Cited by 7
“[36,37] The fear avoidance model focuses on patients’ beliefs about disease, movement, and pain due to erroneous thoughts about the nociceptive experience.”
Background
What is the content of virtually delivered pain management programmes for people with persistent musculoskeletal pain? A systematic review
Booth, G., Williams, D., Patel, H., & Gilbert, A. W. (2021) · British Journal of Pain · doi:10.1177/20494637211023074 · Cited by 8
Health-related quality of life deviations from population norms in patients with lumbar radiculopathy: associations with pain, pain cognitions, and endogenous nociceptive modulation
Bogaert, W. V., Putman, K. D., Coppieters, I., Goudman, L., Nijs, J., Moens, M., Buyl, R., Ickmans, K., & Huysmans, E. (2021) · Quality of Life Research · doi:10.1007/s11136-021-02964-5 · Cited by 7
The Effect of Pain Experienced During the COVID-19 Infection on the Fear of Pain and Quality of Life
Korkut, S., & Ülker, T. (2021) · Pain Management Nursing · doi:10.1016/j.pmn.2021.08.007 · Cited by 7
Prevalence of Long-Term Opioid Therapy in a Chronic Non-Cancer Pain Population Attending a University-Based Tertiary Pain Clinic in Sweden: A Cross-Sectional Study
Grelz, H., Fischer, M. R., Priouzifard, M., Midlöv, P., & Ringqvist, Å. (2022) · Journal of Rehabilitation Medicine · doi:10.2340/jrm.v54.1981 · Cited by 7
“Hospital Anxiety and Depression Scale (HADS) (20), EuroQoL 5D (EQ-5D) (21), Tampa Scale for Kinesiophobia (TSK) (22), Chronic Pain Acceptance Questionnaire (CPAQ-8) (23) and Rand 36 (24), included in the SQPR, were used in the current study.”
MethodInfluential
The Influence of Exercise Intensity on Psychosocial Outcomes in Musculoskeletal Disorders: A Systematic Review
Klaps, S., Haesevoets, S., Verbunt, J., Köke, A. J. A., Janssens, L., Timmermans, A. A. A., & Verbrugghe, J. (2022) · Sports Health A Multidisciplinary Approach · doi:10.1177/19417381221075354 · Cited by 12
“Likewise, movement-related fear often predicts progression of pain intensity, quality of life (QoL), and disability.(46) Exercise therapy is advised as a primary treatment modality for CMSDs.”
Background
Acute Effects of Whole-Body Electrostimulation Combined with Stretching on Lower Back Pain
Silvestri, A., Ruscello, B., Rosazza, C., Briotti, G., Gabrielli, P. R., Tudisco, C., & D'Ottavio, S. (2023) · International Journal of Sports Medicine · doi:10.1055/a-2080-2018 · Cited by 7
“, fear of movement) [10, 11], and the lack of facilities.”
Background
The efficacy of a brief acceptance-based group intervention in a sample of female patients with fibromyalgia and comorbid obesity: a randomised controlled trial
Varallo, G., Cattivelli, R., Giusti, E. M., Landi, G., Spatola, C. A. M., Ruggiero, G. M., Franceschini, C., Tossani, E., Grandi, S., Capodaglio, P., et al. (2023) · Clinical and Experimental Rheumatology · doi:10.55563/clinexprheumatol/7hvaya · Cited by 7
“levels of pain intensity and greater disability in chronic pain and FM (30, 31, 40-42).”
Background
Individual Patterns and Temporal Trajectories of Changes in Fear and Pain during Exposure In Vivo: A Multiple Single-Case Experimental Design in Patients with Chronic Pain
Bontinck, J., den Hollander, M., Kaas, A., de Jong, J. D., & Timmers, I. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11051360 · Cited by 7
“Pain-related fear has been considered an important contributing factor in chronic musculoskeletal pain populations [2,5,6].”
Background
The longitudinal relationship between fear of movement and physical activity after cardiac hospitalization: A cross lagged panel model
Keessen, P., Kan, K., ter Riet, G., Visser, B., Jorstad, H. T., Latour, C. H. M., van Duijvenbode, I. C., & Reimer, W. J. M. S. O. (2024) · PLoS ONE · doi:10.1371/journal.pone.0297672 · Cited by 6
“Nevertheless, kine-siophobia is consistently associated with disability [13, 26, 27].”
Background

Authors: Luque-Suarez, A., Martinez-Calderon, J., & Falla, D.
Affiliations: University of Birmingham (GB)
ORCID: Falla, Deborah
Venue: British Journal of Sports Medicine
Publisher: BMJ
Published: 2018-04-17
Volume: 53
Issue: 9
Pages: 554-559
ISSN: 0306-3674 (ISSN-L)
1473-0480
DOI: 10.1136/bjsports-2017-098673
OpenAlex: W2800915060
Cited by: 546
References: 116
Citations by year: 2026: 98 · 2025: 93 · 2024: 80 · 2023: 87 · 2022: 86 · 2021: 58 · 2020: 33 · 2019: 11
FWCI: 2.98
Type: journal article
Language: en
Open access: green
hdl.handle.net
Licence: other-oa
Locations: British Journal of Sports Medicine (publishedVersion)
PubMed (publishedVersion)
RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
HighWire Press Open Archive (submittedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
Funders: Universidad de Málaga
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: kinesiophobia, chronic musculoskeletal pain, disability, quality of life, pain intensity, Tampa Scale for Kinesiophobia, prognostic value, disability progression
MeSH terms: Cross-Sectional Studies, Fear, Disabled Persons, Persons with Disabilities, Humans, Quality of Life, Musculoskeletal Pain, Observational Studies as Topic

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Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review

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